Have You Gone Caffeine Crazy?

Overdoing It with Caffeine

Almost 90 percent of us kick-start the day with a jolt of caffeine -- 71 percent get their fix from coffee, 16 percent from caffeinated soft drinks, 12 percent from tea -- and that invigorating buzz we crave is available on virtually every street corner. Specialty coffee chains now dispense giant mugs of java, while convenience stores are stocked to the rafters with new caffeinated waters and high-octane energy drinks, which carry names like Cocaine, Krank2O, VPX Redline, Monster Energy, Red Bull, and Full Throttle. In fact, energy drinks make up the fastest-growing segment of the beverage market. Soon you won't have to settle for only drinking your java juice -- a North Carolina scientist has invented caffeine-fortified doughnuts and bagels.

More than ever, in the course of a normal day (a cup or two of coffee in the morning, a soda with lunch, an energy drink for the afternoon slump), those caffeine milligrams can creep up on you. A standard coffee cup once held about 8 ounces, and that amount of non-gourmet coffee has around 100 milligrams of caffeine. A Starbucks 16-ounce grande, however, clocks in at a nerve-jangling 260 milligrams, and if you're a venti gal, you're sucking down 325. Trade regular colas for energy drinks and you can double or triple the amount of caffeine you get. Caffeine also hides in some surprising places: coffee- and cappuccino-flavored yogurt and ice cream, some types of orange soda, and OTC painkillers, including Anacin and Excedrin.

"With all the coffee and energy drinks around, more people are overdoing it with caffeine," says Laura Juliano, PhD, a psychologist at American University who has studied caffeine dependence. "Yet people don't realize the impact it can have on their lives, such as causing chronic sleeplessness and anxiety."

What's more, caffeine sensitivity varies widely. Though no one can say exactly how many milligrams of caffeine are too much, we all have an individual caffeine tipping point. And because caffeine is habit-forming, it takes strategizing to make sure you get the boost you want when you need it without building a tolerance to the point that you're getting a health-jeopardizing overload. Making it tougher to track your intake: There's no FDA requirement mandating that a product's nutrition label include how much caffeine it has. In March 2006, however, Pepsi-Cola started voluntarily listing caffeine on content labels of some products. In November 2006 Coca-Cola followed suit.

Are You Hooked?

There's no question that caffeine is habit-forming. Taking in as little as 100 milligrams daily, about what you get in one 8-ounce cup of non-gourmet coffee, can produce withdrawal symptoms if you abstain. "Caffeine use is so widely accepted that we've become blind to the fact that this is a mood-altering drug," says Roland Griffiths, PhD, a behavioral pharmacologist at Johns Hopkins University. "About half of regular caffeine drinkers experience withdrawal symptoms when they wake up."

Caffeine takes about 10 to 15 minutes to get into the bloodstream and peak levels can be reached in 45 minutes, according to James D. Lane, PhD, director of the Duke University Medical Center Psychophysiology Laboratory. The effects don't wear off for four hours or more. Because your body habituates itself to caffeine over time, people who use it regularly may need escalating doses to get the same effect (see "'This Is Your Brain on Caffeine'").

When regular drinkers don't get their fix, they can feel draggy, irritable, and unfocused. For about half of regular coffee drinkers, going cold turkey can trigger a full-blown withdrawal syndrome -- nausea, muscle aches, throbbing headaches. In 13 percent of cases symptoms are so severe they interfere with functioning. "Caffeine withdrawal can be terrible, like having a bad case of the flu," says Dr. Juliano.

Some people can get trapped in what experts call the "stimulant-sedative loop." Caffeine causes insomnia, so they pop a pill to sleep at night. When they wake up, it takes caffeine to stay alert during the day. This disturbs the body's normal sleep/wake cycle.

A slew of recent studies tout coffee's potential to prevent liver and colon cancer, heart disease, type 2 diabetes, and Parkinson's disease. Scientists attribute these benefits to the antioxidants and minerals contained in coffee beans -- in short, it's other stuff in coffee, not the caffeine, that provides them. These compounds help the liver process blood sugar, which may be why drinking coffee seems to reduce the risk of diabetes. Antioxidants may also play a role in preventing heart disease and liver and colon cancer by curbing the cell damage that contributes to the development of these diseases. Coffee, in fact, is the number one source of antioxidants in our diets, according to a 2006 University of Scranton study. "Nothing else comes close," says Joe Vinson, PhD, a professor of chemistry at the university, who ran this research.

Caffeine itself -- from coffee and other sources -- has health benefits, too. It boosts energy, improves alertness and reaction time, helps us learn better, increases stamina, and fires up the metabolic furnace. Two recent studies reveal it can even help memory: In a 2005 Austrian study, 100 milligrams a day increased activity in the part of the brain responsible for short-term memory and improved performance on a memory test. And in February, Dutch researchers found that three cups of coffee a day slowed the loss of mental function in men.

When the Buzz Goes Bad

But too much caffeine -- especially if you don't recognize your threshold -- can have substantial health risks. The reason coffee and other caffeine sources rev us up is that they raise adrenaline -- up to 32 percent over normal levels -- according to a series of studies led by Dr. Lane. While this can temporarily boost energy, it can also trigger heart palpitations, temporarily raise blood pressure, and lead to insomnia. "Caffeine keeps people awake by preventing the brain from recognizing when it's tired, which disrupts our natural sleep patterns," says Dr. Lane, who has studied caffeine for nearly 20 years.

Whereas moderate caffeine consumption has energy and alertness benefits, excessive consumption seems to tip the scales. Drinking more than five cups of non-gourmet coffee a day (people in Dr. Lane's study drank 500 milligrams of caffeine) can exaggerate the effect of stress and magnify a person's response to pressure. This can leave you tired and cranky, impairing your ability to handle difficult situations calmly. "A stressful day is made more stressful by high doses of caffeine, which increase the feelings of being burned-out and depleted," says Dr. Lane. This makes caffeine a bad choice for those prone to depression or anxiety disorders.

For people who are slow to metabolize caffeine (see "Could Caffeine Be a Health Risk?"), the substance can be dangerous. And some ultra-high-caffeine products can be risky, period. From January 2004 to June 2006 California poison-control center toxicologists reported 10 calls from people (age range: 13 to 53) who ingested one to two 8-ounce cans (250 milligrams of caffeine each) or two or more teaspoons of powdered concentrate (250 milligrams per teaspoon). Four wound up in the ER. And Chicago poison-control officials noted an emerging caffeine-supplement abuse problem among young people, putting 31 of more than 250 poison-control center callers in the hospital. Overdose can cause chest pain, heart palpitations, tremors, sweating, nausea and neurologic symptoms, notes the American College of Emergency Physicians.

Does caffeine upset the stomach? Research on this is mixed, says William D. Chey, MD, an associate professor of medicine at the University of Michigan in Ann Arbor, who recommends having no more than one cup a day to avoid heartburn. Folgers Simply Smooth, one of a growing line of "stomach friendly" brands, comes in caffeinated and decaf versions designed to avoid the problem.

How Much Is Too Much?

How much is too much? That's highly individual. "What can feel like one cup to me can feel like 10 cups to someone else," says Dr. Juliano. Some people have health issues or a metabolic defect that makes caffeine dangerous. Women who are pregnant or taking birth control pills also metabolize caffeine more slowly than normal. Watch your response and be aware that your sensitivity can change over time.

"Everyone has his or her own threshold," says Terry E. Graham, PhD, a caffeine researcher at Ontario's University of Guelph. "In most cases our body tries to tell us when the dose of caffeine is too much -- we'll be hit with feelings of anxiety, we'll feel down or have trouble concentrating or sleeping."

In general, about 300 milligrams of caffeine a day (the amount in three 8-ounce cups of non-gourmet coffee) can be energizing without making your heart race. Timing is important, too: Because it takes four to six hours for the body to excrete even half of the caffeine you've consumed, those jolts of java in the afternoon can keep you revved up at night. If you have insomnia, stop ingesting anything with caffeine after noon, so the drug can get out of your system by bedtime.

If you're someone who values the way caffeine enhances your focus, stamina, and mood and don't have health reasons to cut back, it makes sense to use caffeine strategically to get the boost when you need it without risking overload. Here's how:

• Spread out your consumption. To maximize caffeine's energy- and mood-boosting effects, studies say that it's best to sip the equivalent of a quarter of a cup of coffee every hour or so. "If you drink two to three cups of coffee at once, your body gets more than it can absorb and it all wears off at once," says Dr. Vinson. Smaller amounts give you a series of mini-jolts and are a safe way to keep the buzz going through the day without ingesting more caffeine than is safe.
• Keep daily intake low -- to keep caffeine's impact high. The tolerance your body develops can undercut your ability to use caffeine for extra focus and energy on a tough day. Try getting used to less on low-key days (say, no more than two cups, enough to give you a mild buzz and avoid withdrawal pangs). This lets you safely load up on days when you may need the extra jolt.

This Is Your Brain on Caffeine

The reason we feel alert after drinking a cup of coffee is that caffeine both stimulates production of adrenaline (which revs you up) and blocks your body's receptors to adenosine (a chemical that makes the body sleepy). When your body adapts to caffeine, it develops extra adenosine receptors to compensate for the ones that are blocked. This change has two effects: It increases the amount of caffeine you need to get a caffeine buzz (from one 8-ounce cup to two) and it sets you up for withdrawal when you miss your daily dose. The reason? Those extra receptors let more than the usual amount of adenosine reach your brain. Result? Fatigue.

Having an energy drink like Red Bull is a strategy some people (especially teens and young adults) use following a night of drinking, thinking it will make them more alert at the wheel. Not only is this not true, but the combination can be especially lethal. In a recent study of 26 healthy young volunteers, energy drinks did nothing to reduce alcohol's effects on motor coordination and reaction time, but they made subjects feel less intoxicated. "The energy drinks mask the symptoms of alcohol so people don't know when they should stop," says Maher Karam-Hage, MD, a psychiatrist and addiction specialist at the M.D. Anderson cancer center. "They may drink more because they don't feel sleepy or even drive when they're impaired, which could be deadly."

A "Smart" Drug That's Better Than Coffee?

"Take it," my colleague said, holding out an oblong white pill in his palm. We were attending a scientific conference in Basel in the dead of winter. The drug was Provigil, a wakefulness promoter doctors prescribe to treat sleep apnea and narcolepsy.

To say I was jet-lagged wouldn't do justice to how tired I felt. There's a nine-hour time difference between Los Angeles, where I live, and Basel, and I hadn't been in Switzerland nearly long enough to adjust. Earlier that evening it had taken all the self-control I could muster to avoid falling headfirst into a bowl of soup at dinner. I was working on a documentary and had been running on fumes all day long, lining up key people to interview on camera, and I had an even longer day of filming ahead of me the following day.

My friend thought Provigil could help.

I was nervous because even a single latte makes me hyper. But after breakfast the next morning I took the plunge and joined the ranks of a growing underground army of high achievers who get prescriptions to order it online -- as well as the routinely sleep deprived who persuade their doctors to prescribe it off-label.

Provigil has become an especially attractive way to stay alert through 18-hour days because it rarely causes the jitters, insomnia, or the inevitable crash that comes from mainlining coffee. Instead of feeling edgy, users may feel focused and better able to concentrate, even if they haven't slept well the night before.

Part of its appeal is that Provigil doesn't seem to be physically addictive or have known serious side effects, though it can become a crutch for workaholics. It's been used safely since 1994 in Europe, according to sleep expert Jerome Siegel, PhD, a professor of psychiatry and bio-behavioral sciences at UCLA. "There are no consistent major problems," says Dr. Siegel.

A "Smart" Drug, continued

According to Provigil's marketer, Cephalon, of Frazer, Pennsylvania, since the drug was approved, in 1998, sales have jumped from $150 million in 2001 to $513 million in 2005. Clearly it's not being prescribed just for narcoleptics and people with sleep disorders, the uses for which it is FDA approved.

Though the FDA declined to approve Provigil for excessive sleepiness from causes other than narcolepsy or recognized sleep disorders, off-label use of the drug is huge, claims Dr. Siegel. Provigil is reportedly used to treat fatigue, depression, attention deficit/hyperactivity disorder and sleepiness caused by other medications, such as narcotic painkillers. The company has a longer-acting version in the pipeline, Nuvigil, which might be available sometime this year.

If my own experience is any barometer, I can see why Provigil is so popular. When I arrived at the makeshift studio we had set up in a hotel conference room, my producer and my writing partner were already there.

"How do you feel?" asked my equally jet-lagged writing partner.

"Clear," I responded. I had to stop and think for a minute because the difference was so subtle, but that was exactly how I felt -- not buzzed or hyper-vigilant, but simply a more-alert version of me. We ended up shooting for nearly 10 hours, and my energy didn't flag once. Throughout the long day I was calm and focused and felt more productive and attentive than I could remember having been in a while. That night I slept soundly from the moment my head hit the pillow.

In the year since, I haven't repeated my little experiment with Provigil, mainly because I don't want to use it as a crutch or seem like a junkie to my family doctor. Occasionally, though, when I'm crunched by looming deadlines and virtuously sipping tea isn't getting the juices flowing enough to work productively for hours on end, I'm sorely tempted to surf the Net for a Mexican pharmacy. But then I come to my senses. --L.M.

Could Caffeine Be a Health Risk?

Yes. Some people should cut back on or completely avoid caffeine. Check with your doctor if any of the following are issues for you:

• Certain medical conditions Avoid caffeine if you have hypertension, heart disease, interstitial cystitis, polycystic kidney disease (caffeine promotes cyst enlargement), or anxiety or panic disorders. You should also avoid using it in combination with certain medicines, including bronchodilators, anti-anxiety pills, and quinolone antibiotics.
  

  
  
  Recommendation: Abstain completely.

• At risk for osteoporosis Excessive caffeine can weaken bones and bone loss accelerates once we lose estrogen at menopause. Consuming more than 300 milligrams of caffeine a day (three 8-ounce cups of regular coffee) depletes calcium if dietary calcium is inadequate, according to a 1998 Washington State University study. This can speed bone loss in post-menopausal women. "The more coffee a woman drinks, the more calcium is excreted in her urine," says Linda Massey, PhD, a calcium researcher at Washington State University. For every six ounces of coffee, we lose five milligrams of calcium (women need 1,000 milligrams a day for strong bones).
  

  
  
  Recommendation: No more than two cups a day -- and be sure to compensate for the calcium loss by drinking a cup of milk for each cup of coffee (any kind of milk is fine).

• Slow coffee metabolizer Too much coffee can boost heart-attack risks in people with a genetic defect that makes them metabolize caffeine more slowly than normal, allowing caffeine to build up in their system. For them one cup may be equivalent to four cups in people without this DNA variant. Slow metabolizers who drink two to three cups a day had a 36 percent higher risk of heart attack, according to a 2006 Journal of the American Medical Association study. Odds jumped to 64 percent if they drank four or more cups of coffee a day, compared with those drinking little or no coffee. There's no standard way of determining whether you metabolize caffeine slowly: researchers used a costly genetic test, but tests sold over the Web are for consumer use without doctor supervision. Your response to caffeine is a good barometer -- if you think you might be a slow metabolizer, ask your doctor.
  

  
  
  Recommendation: Abstain completely.

• Pregnant or want to be Drinking 500 milligrams of caffeine a day -- about five 8-ounce cups -- can delay conception and double the risk of early miscarriage. Research also shows more than 300 milligrams (or three cups) daily can double the risk of delivering an underweight baby. "If you're pregnant or want to have a baby, cut out caffeine or drink no more than one cup a day," says Bonnie Liebman, director of nutrition for the Center for Science in the Public Interest, in Washington, D.C.
  

  
  Recommendation: One cup per day at most.

Originally published in Ladies' Home Journal, June 2007.